How Do I Know If My Child Is Due For A Texas Health Steps Checkup
Texas Health Steps will send you a letter when itâs time for your childâs medical and dental checkups. You can also visit YourTexasBenefits.com or call the number below to find out if your child is due for a checkup.
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Make Changes To Your Medicare Plan Coverage During The Right Time Of Year
One especially useful time to review your Medicare coverage is during the fall Annual Enrollment Period, or AEP.
The Medicare AEP lasts from every year. During this time, Medicare beneficiaries may do any of the following:
- Change from Original Medicare to a Medicare Advantage plan
- Change from Medicare Advantage back to Original Medicare
- Switch from one Medicare Advantage plan to another
- Enroll in or drop Medicare Part D coverage
- Switch from one Part D plan to another
Outside of AEP, your opportunities to make changes to your Medicare plan can be limited.
Another time you may be able to change your Medicare plan include:
- Special Enrollment Periods You could potentially qualify for a Special Enrollment Period at any time throughout the year, if you meet one of a set of certain circumstances. This can include moving out of the area serviced by your current plan, losing your current plan because it is no longer offered in your area, and a number of other certain circumstances.
How Can You Find Out If Someone Is On Medicaid
Contact your state Medicaid office to ask about Medicaid eligibility tools. Many states offer online benefit-checking tools that require entering an individuals name and either a Social Security number or Medicaid number. Enter in all requested information in the forms on the benefit eligibility screening tool.
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Find Out What Medicare Plan May Fit Your Needs
Did you know that you could potentially find a Medicare Advantage plan with $0 premiums, $0 deductibles and an annual out-of-pocket spending max?
$0 premium plans may not be available in all locations, so it may be helpful to speak with a licensed insurance agent who can help you compare plans where you live.
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelors degree in journalism.
Medicare has neither reviewed nor endorsed this information.
What Medicaid Helps Pay For
If you have Medicare and qualify for full Medicaid coverage:
- Your state will pay your Medicare Part B monthly premiums.
- Depending on the level of Medicaid you qualify for, your state might pay for:
- Your share of Medicare costs, like deductibles, coinsurance, and copayments.
- Part A premiums, if you have to pay a premium for that coverage.
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Can You Have Both
People who qualify for both Medicare and Medicaid are considered dual eligible. In this case, you may have original Medicare or a Medicare Advantage plan , and Medicare will cover your prescription drugs under Part D.
Medicaid may also cover other care and drugs that Medicare doesnt, so having both will probably cover most of your healthcare costs.
Qualified Medicare Beneficiary Only
Qualified Medicare Beneficiary Only is a Medicaid-funded program that provides financial assistance to cover Medicare Part A and Part B premiums. It also covers Medicare deductibles, coinsurances, and copays.
This program does not cover medical supplies. For example, someone with QMB cannot use it to receive incontinence products.
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What Is The Medicare Savings Program
Medicare Savings Programs are Medicaid programs for Medicare beneficiaries with limited income and resources. These programs help beneficiaries pay for their Medicare benefits. For example, some of these programs pay premiums, such as the Medicare Part B monthly premium.
There are four types of Medicare Savings Programs:
Qualified Medicare Beneficiary
Specified Low-Income Medicare Beneficiary
Qualified Disabled Working Individual
Each program will have different income and resource eligibility limits. Learn more about Medicare Savings Programs at this resource.
What Does The Medicaid Spend Down Mean
For those whose incomes exceed the Medicaid income limits, some states allow interested persons to spend down to become eligible for the Medicaid program. The spend down process allows potential beneficiaries to subtract their medical expenses from their income.
Note: Find a Medicare-Medicaid plan here.
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What If I Dont Want My Medicaid Doctors And Providers To See My Health Information Through This Website
You can âopt outâ of sharing. âOpt-outâ means that you choose not to share your health information. To opt out, go to and then:
You can also opt out by calling 800-252-8263. If you opt out, we wonât share your health information with Medicaid doctors or other providers.
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Qualifying For Different Types Of Coverage
Medicare is a federal insurance program that helps pay medical bills from a fund to which users have contributed. It covers people 65 and older, people younger than 65 with certain disabilities and patients with end-stage kidney disease and other conditions requiring dialysis. Participants usually pay part of the cost.
Medicaid is an assistance program provided jointly by federal and state agencies. It helps with medical expenses for eligible people with limited income and resources.
There are different rules for each state, but in most states, you may be eligible for Medicaid if you are under certain income levels and/or are:
- 65 and older
- A parent or adult caring for a child
- An adult with dependent children
- An eligible immigrant
Participants usually pay nothing for covered medical costs, although they may sometimes be responsible for a small copayment or cost share.
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What Is Medicare Vs Medicaid
Medicare and Medicaid are not the same. Many confuse the benefits of Medicare vs. Medicaid as they are both government-run health insurance programs in the United States. However, Medicare is federal, and Medicaid differs by state.
Medicare benefits are the same across all states and U.S. territories. Typically, Medicare benefits are available to those 65 and over or receiving Social Security Disability benefits under 65. Medicare offers standardized premiums that are consistent for those in the same income bracket.
On the other hand, each states government operates Medicaid. Every state has different qualifications and requirements for enrollment in Medicaid. While there is no age requirement for Medicaid, there is a financial requirement. Your income and resources may not exceed state-specific thresholds to be eligible for Medicaid coverage. Medicaid coverage typically comes at no cost to the beneficiary.
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To differentiate the two, with Medi-care, think of care for those 65 and over or those with disabilities. Then, Medic-aid is an aid to those with a low income.
Do You Need More Help
If you arent sure if your Medicaid coverage has been approved yet or if it is still active, you can check Manage My Case or call the states Automated Voice Recognition System at 1-855-828-4995 with your Recipient Identification Number .
If you have an urgent medical need and need Medicaid quickly, call the DHS Helpline at 1-800-843-6150.
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How Can I Find My Medicare Number Without My Card
Need your Medicare Number but dont have your Medicare card? No need to worry you have a few options for retrieving your Medicare Number.
If you forget to bring your card to an appointment with your doctor or healthcare provider, they may be able to look it up for you.
Lost or damaged Medicare cards can be easily replaced. Give Medicare a call at 1-800-633-4227 or log into your Medicare.gov account.
When And How To Apply For Medicare
You can sign up for Medicare three months before your 65th birthday, though people with certain disabilities who are under the age of 65 may also apply. Coverage typically kicks in at least one month after you sign up.
Medicares open enrollment period occurs annually from October 15 through December 7, during which time you can add or augment your coverage. Coverage typically begins January 1 for those who enroll by December 7. The Medicare Advantage open enrollment period runs from January 1 through March 31.
To enroll in Medicare, you can either:
- Apply online at SSA.gov.
- Visit your local Social Security office to apply in person.
After you enroll, youll receive your card and a welcome package in the mail to confirm your coverage and benefits.
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Using Medicaid With Medicare Or Other Medical Insurance
If you have both Medicare and Medicaid, they work together for you. Medicare pays first, and Medicaid pays last.
Medicare has two parts: Medicare Part A and Medicare Part B
Medicare Part A:
- Pays for skilled nursing care and hospital services.
- Pays for most of your hospital expenses.
Medicaid will pay most of the hospital bills that Medicare Part A doesnt pay. You may be billed for a small amount, called co-insurance. You might also have to pay part of the deductible for inpatient hospital care.
Medicare Part B:
- Pays for visits to the doctor
- Pays for lab tests and X-rays.
Not everyone on Medicare has Part B. You have to pay a small amount each month. Medicaid will pay this monthly charge for you. Let your DHS county office know you have Medicare Part B so you wont be charged a Medicare premium. Medicaid also pays most of the charges that Medicare Part B will not pay. You may be billed for a small amount.
If you have health insurance and Medicaid:
Other times when Medicaid will not pay until someone else pays:
- If you are hurt in a car accident, Medicaid will not pay until your car insurance or the other drivers car insurance has paid or denied payment.
- If you are hurt on the job, Medicaid will not pay until workers comp has paid or denied payment.
- If you win a lawsuit because you got hurt or you get a cash settlement from such a lawsuit, you must use the money to pay your medical bills. Medicaid will only pay toward any amount of your medical bills that are left over.
How Much Does Medicaid Original Medicare And Medicare Advantage Cost
Medicaid members generally pay no premium and cost sharing is nominal, according to requirements set by the federal government. Most states dont charge Medicaid members a premium, says Garfield. And copays for services that have cost sharing are as little as $1 to $3, she adds.
Meanwhile, costs for Original Medicare and Medicare Advantage differ. See how they compare in the table below.
|Deductibles vary according to a persons specific plan. There are many plans with no deductible|
|Out-of-Pocket Costs’||Part A: Coinsurance varies depending on the length of a hospital stay per benefit period. There is a $0 coinsurance for the first 60 daysPart B: There is a 20% coinsurance after youve met your deductible for Medicare-covered services||Coinsurance and copayments vary according to plan|
|Out-of-Pocket Maximum||There is no limit to your out-of-pocket costs||Out-of pocket costs’ are capped. In 2021, the out-of-pocket maximum is $7,550, though some plans set lower limits. If youre in a plan that allows out-of-network coverage, theres a separate out-of-pocket limit for combined in- and out-of-network coverage of $11,300|
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Not Enrolled To Medicaid Heres How To Apply
If you have not yet enrolled yourself and/or your family, there are multiple methods you can use to enroll in Medicaid. Your first option is to enroll yourself and/or your family by going online and filling out an application for yourself and/or your family at the Health Insurance Marketplace. There you can follow the steps to create an account and provide your information such as whether or not you have a disability, your income level, and enroll any minor dependent children you have in health coverage programs such as the Childrens Health Insurance Program, otherwise known as CHIP.
Another method you can use to enroll in the Medicaid program is to directly contact your states Medicaid agency. You can find the agency contact information you need by visiting the Healthcare website. Scroll down to the state in which you reside, and you will be taken to the website of your local Medicaid agency. There you will be provided with telephone numbers for your local Medicaid agency which you can call during normal business hours in order to check if you and/or your family qualify for Medicaid.
What Are Dual Special Needs Plans
Dual health plans are also known as dual special needs plans. Theyre offered by private insurance companies, so you can find a dual health plan that best meets your health insurance needs. Being on a dual health plan does not change your Medicaid eligibility or benefits.
See UnitedHealthcare plans in your area.
Dual-eligible or Medicaid plan benefits can change depending on where you live. Search using your ZIP code to find the best plan to meet your health care needs.
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Looking for the federal governments Medicaid website? Look here at Medicaid.gov.
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What Is Medicare Advantage
Medicare Advantage plans, also known as Medicare Part C or MA plans, are supplemental Medicare plans. Medicare Advantage plans bundle Medicare Part A and Part B into one health insurance plan. MA plans are offered through private insurers that are Medicare-approved.
Most Medicare Advantage plans also have additional benefits, including dental, hearing, and vision coverage. MA plans also often include Medicare Part D within its policies.
Using Your Healthy Connections Plan
Q. What medical services does Medicaid cover? A. Within certain limits, Medicaid will pay for services that are medically necessary. Examples of services that may be covered include doctor visits, medications, hospital visits, and many other medical services.
If you have any questions about what is covered, to view a chart that shows each health plan and what they cover. You can also contact Healthy Connections toll-free at 1-888-549-0820.
Q. How long will my Medicaid benefits remain active? A. Eligibility for most Healthy Connections programs lasts for 1 year. After 1 year, South Carolina Health and Human Services will review your case annually.
Q. I was enrolled in S.C. Healthy Connections Choices and now am told I must choose between health plans. What should I do? A. The Healthy Connections Choices website offers comprehensive information on its health plans. Members may utilize a Quick Start Guide, search for doctors, compare plans, and more. Please visit S.C. Healthy Connections Choices for more information.
Q. Do I need to tell South Carolina Healthy Connections when I move or change jobs? A. Yes. If you have any changes to your income, resources, living arrangements, address or anything else that might affect your eligibility you must report these changes to Healthy Connections right away at 1-888-549-0820.
Q. What if my Medicaid card is lost or stolen? A. Report a lost or stolen card to Healthy Connections immediately at 1-888-549-0820.
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Are You Dual Eligible
Some people can be eligible for both Medicare and Medicaid at the same time.
Dual-eligible beneficiaries are individuals who are eligible for both Medicare and Medicaid.
People who are dual eligible share costs with state-run Medicare Savings Programs , which provide help with premiums, deductibles, coinsurance and copayments, depending on the participant’s income level and the specific MSP. There are programs where eligible participants may have no copayments or cost shares.
This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult your doctor to determine what is right for you.
Humana is a Medicare Advantage HMO, PPO and PFFS organization and a stand-alone prescription drug plan with a Medicare contract. Humana is also a Coordinated Care plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in any Humana plan depends on contract renewal.
Some links on this page may take you to Humana non-Medicare product or service pages or to a different website.